southkentccg

Transcription

1

2 Foreword The NHS South Kent Coast Clinical Commissioning Group is responsible for the planning and funding of NHS health services for the people of: Deal, Dover, Folkestone, Hythe, Romney Marsh and surrounding areas. This is the fifth annual report produced by NHS South Kent Coast Clinical Commissioning Group (CCG). It reflects on and includes an overview of the CCG s governance arrangements and progress against financial and operational targets. It also includes our full financial accounts. If you would like to find out more about our ambitious plans, then you can read about these in our Annual Operating Plan, published on our website. If you have any questions or feedback, please get in touch we are always happy to hear from southkentccg 2

3 Contents PERFORMANCE REPORT... 4 Performance Overview... 4 Performance Analysis ACCOUNTABILITY REPORT Corporate Governance Report Members Report Statement of Accountable Officer s Responsibilities Governance Statement Remuneration and Staff Report Remuneration Report Staff Report Parliamentary Accountability and Audit Report ANNUAL ACCOUNTS INTERNAL AUDIT OPINION EXTERNAL AUDIT OPINION

4 PERFORMANCE REPORT This section of the report provides information on the purpose and activities of the organisation. It details our main objectives and our principal risks. Performance Overview This overview is designed to provide a short summary of the purpose of the organisation, the key risks to the achievement of our objectives and how we performed during Statement from the Accountable Officer Partnership working has been a strong theme throughout the year as we build a future health system that we can all be proud of and that provides the best care to all our patients. The need to transform local services is clear, so we can bring about fundamental changes to how we deliver and how patients use health and care services. This level of change is not something that can be developed by us alone and that is why working with our partners in health, social care and the wider community on designing future services is so important. Our GPs and colleagues in general practice have provided a strong foundation for developing local care with our partners, which can provide tailored support for patients and help them stay healthy and independent. Our hard work at fostering relationships has been recognised in a 360 degree survey with our stakeholders, which had some positive headlines and has given us clear areas for development. This year we have joined with the other CCGs in Kent and Medway to work towards developing a strategic commissioner function with a shared single senior management team and one Accountable Officer. Making strategic commissioning decisions across multiple CCGs will provide consistency and reduce duplication - it will help improve services for patients by reducing variation in quality and access to care and will drive up standards across all providers. The four east Kent CCGs (NHS Ashford, NHS Canterbury and Coastal, NHS South Kent Coast and NHS Thanet) have also established a joint committee to consider the future of urgent, emergency and acute medical care including specialist services, and planned orthopaedic care. As part of this, we reached out to hundreds of people through six listening events across the area to further develop our thinking. This is a crucial part of our early work and will help inform the next stage of evaluation before formal consultation begins. 4

5 Our partnership working with other parts of the NHS has stretched to London and Sussex as we seek to create improved stroke services for our patients. Clinical commissioning groups in Kent and Medway, parts of south London and East Sussex held a total of 28 public events as we collectively talked with our populations about how to improve services by setting up hyper acute stroke units. All the feedback received will be considered by the ten CCGs who are represented through the joint consultative committee for stroke. We are also working on great improvements in our local area. GP practices across Dover, Deal and Shepway launched a home visiting service to help sick and housebound local people get the care they need when they need it. The new team led by paramedics, senior nurses and healthcare assistants will offer some 16,000 contacts per year. In most cases they will provide a package of care and support to help patients get better in their own home. They will also be able to arrange and transport patients to visit a GP if necessary, or for hospital care if they are very ill. We ve also seen improvements in mental health services. By working in partnership with other CCGs in Kent and colleagues in Kent County Council s public health team, we have developed a much improved service specification for children and young people s emotional wellbeing and mental health services. From September 2017, children and young people who need support have benefited from a more joined-up service under an innovative new contract run by NHS North East London Foundation Trust (NELFT). We cannot however ignore the huge challenges the CCG and the wider health and care services have faced over the past year and these have been described throughout this report. As we look towards the future we will continue to build upon our local care story, offering more high-quality services to patients, and working with our provider partners to support them to achieve the NHS constitutional standards whilst recovering a system-wide financial position that is in deficit and building resilience into our workforce, our estate and the care we aspire to deliver. Glenn Douglas Accountable Officer 25 May

6 Purpose and activities of the organisation Clinical Commissioning Groups (CCGs) are statutory NHS organisations made up of GP practices from the local area. The CCG was established in April 2013 under the Health and Social Care Act 2012 as a body corporate. The CCG has responsibilities for commissioning services to meet the healthcare needs of the local population. This includes the following services: Community health services (except where part of the public health service) Elective hospital care Healthcare services for children including those with complex healthcare needs Healthcare services for people with learning disabilities Healthcare services for people with mental health conditions Maternity services NHS continuing healthcare. Older people s healthcare services Rehabilitation services Urgent and emergency care including Accident and Emergency, ambulance and out of hours services Wheelchair services With effect from 1 April 2017, the CCG took on delegated responsibility, from NHS England, for the commissioning of primary medical services (also known as general practice). Under the delegated arrangements, NHS England continues to hold GP contracts, but the CCG has become responsible for the day-to-day management of these. Although the CCG does not commission pharmaceutical services, we are responsible for the costs of prescriptions written by local GPs. We do not commission dental services or sight tests. Specialist health services, such as secure psychiatric services, continue to be commissioned by NHS England The CCG is required to have a governing body which is made up of elected clinicians and lay (independent) members who run the CCG on behalf of the membership. The Governing Body is responsible to the practices for planning healthcare services that our patients require. For details of staff numbers and their composition, refer to the detail within the Remuneration Report on page 49. During the course of the year the CCG spent million to deliver healthcare services for the population of the CCG area. However we spent more than we were allocated in 2017/18 which has resulted in the CCG reporting a deficit of 7.285m in the year. The need to balance our books and create long term financial sustainability across the whole of the health system highlights the need to deliver our plans for transformation.. 6

7 The vast majority of the CCG budget was spent on care provided in a hospital: other services such as specialised care, the healthy child programme, pharmacy and optometrists were paid for by NHS England. Kent County Council commission s public health services, such as sexual health, stop smoking and healthy weight programmes. Overall the health of residents within the CCG area is around the national average, however there are significant variations in the health and life expectancy of our population in different parts of the CCG. We understand that supporting people to improve their health, preventing ill health and reducing health inequalities benefits the people involved, their families, the wider community, and the NHS. It improves the quality and length of people s lives and reduces the demand on our services. Tackling health inequalities is both complex and not solely in our gift, however the CCG has a duty to reduce inequalities and has been working hard throughout with its partners and stakeholders through the Health and Wellbeing Board to develop plans that tackle health inequalities. The CCG s annual operating plans have been reviewed by the local and Kent-wide Health and Wellbeing Boards and reflect the Joint Health and Wellbeing Strategy. The South Kent Coast Health and Wellbeing Board is chaired by the CCG s Deputy Clinical Chair, Dr Joe Chaudhuri, and the CCG s Accountable Officer is a member of the Kent Health and Wellbeing Board. The role of the Health and Wellbeing Board is to create a forum where key leaders from the health and social care system work together to improve the health and wellbeing of their local population and reduce health inequalities. NHS England Assessment NHS England has a statutory duty to conduct an annual performance assessment of every CCG. The assessment is a judgement reached by taking into account the CCG s performance in each of a range of indicator areas over the full year and balanced against the financial management and qualitative assessment of the CCG s leadership. This assessment is known as the CCG Improvement and Assessment Framework. The framework covers a range of indicators within four key domains: Better Health Better Care Sustainability Leadership In addition, the framework focuses on six clinical priority areas; cancer, dementia, diabetes, learning disabilities, maternity and mental health. 7

8 The results of this assessment are published on the My NHS website; During 2016/17 the CCG was rated good overall, although assessments in progress within clinical priority areas highlighted areas for improvement; with particular focus on cancer, dementia and mental health. The results for 2017/18 have not yet been published but given the CCGs reported financial deficit and some emerging areas in leadership and governance highlighted as requiring improvement by an independent governance review, the 2016/17 rating is not expected to be maintained. Recovery plans are in the process of being drafted and actions to address leadership and governance gaps have already been taken. Our vision and values We established our vision in consultation with all our GP colleagues and with the public. Our long-term strategic goals are to: Do all that we can to improve the health and outcomes of the people who live in our area, prioritising and tackling mental health and cancer Address the variation in quality of local healthcare services and the inequality of health outcomes that this can cause Ensure that local health and social care services are integrated and that patients experience joined-up care Ensure that services are provided locally wherever possible Work with partners to help prevent ill health We are committed to working with local hospitals and other organisations to make sure that every patient has a positive experience of healthcare. The quality, safety and compassion of the care provided is of paramount importance to us and forms the cornerstone of all our work. We are committed to working with our providers to ensure that patient rights set out in the NHS Constitution are honoured. These include the right to choose your hospital, to be treated within the maximum waiting times, to be treated with dignity and respect, putting mental health on a par with physical health and for any complaints to be investigated properly. The Governing Body and the Quality, Performance and Assurance sub-committee continue to work to ensure that the services the CCG commissions are safe, clinically effective and provide an excellent experience for our patients. In commissioning and performancemanaging providers, we take a vigilant, zero-tolerance approach to breaches of quality and safety. We encourage our patients to recognise their responsibilities for their own health, including taking steps to maintain their good health and wellbeing, registering with a GP practice, 8

9 following courses of treatment they agreed to, treating NHS staff and other patients with respect, using services responsibly and giving feedback about treatment in our services. The priorities set out in our Strategic Commissioning Plan were developed in consultation with local residents and informed by Kent County Council s Joint Strategic Needs Assessment (JSNA), the local health and wellbeing strategy and national policy. Each priority was led by a GP clinical lead and supported by a team of commissioning staff. Patient and public views were incorporated in both the setting of these priorities and as the work programme emerged, which ensured that a patient and clinical perspective was at the core of every discussion and decision. Our vision and goals within our plan have not been developed in isolation and reflect the broader strategic context in which we operate as statutory bodies. There are a number of external factors and influences, plus national requirements on which we are mandated to deliver. Much of the basis for the Government s mandate to NHS England is the NHS Outcomes Framework which describes five main categories of better outcomes demanded from local services. Our ambitions will always be focused on delivering the outcomes in these domains. Our priorities also dovetail with the Kent Health and Wellbeing strategy, and we aimed to ensure: Every child has the best start in life People take greater responsibility for their own health The quality of life for those with long-term conditions is improved with quality care and support Those with mental ill health are supported to live well People with dementia are assessed and treated earlier. Strategic Objectives We will develop and deliver the Sustainability and Transformation Plan We will develop and deliver Local Care Models We will meet our financial targets, particularly returning to financial balance delivering the key savings projects We will deliver the constitutional and access standards, and NHSE Clinical Priorities We will improve the quality and sustainability of primary care We will implement plans to transform care for people with learning disabilities. We will improve patient experience, quality and safety 9

10 Key risks to the delivery of our objectives To make it more likely that we achieve these objectives we practice risk management identifying risks to their achievement and then develops plans to reduce the likelihood or impact of these risks occurring. The most significant risks identified and managed by the CCG during are detailed in the Governance Statement section of this Annual Report and include achieving financial balance, delivering system wide transformation, ensuring high quality safe care is provided to all patients and developing a resilient primary care. At each meeting of the Governing Body, key risks to the achievement of our objectives are reviewed, together with the actions we have in place to address the risks. These are all presented to the Governing Body in a document called the Governing Body Assurance Framework, and the Governing Body receives additional assurance reports providing it with further assurance of actions being taken. The Governing Body then determines whether any further action is required to address these risks. Monitoring The CCG monitors provider s performance through monthly quality and performance meetings, and reviews the CCG s progress toward delivering these targets through the monthly Quality, Performance and Assurance Committee with quarterly reports to the Governing Body. The CCG collects and monitors performance data through national statutory reports submitted by providers to NHS Digital and through data flows compiled by the Commissioning Support Unit (CSU) and made available through a data warehouse accessible by the CCG. New standards are discussed and data collections planned through provider technical meetings, and monitored through performance meetings. The CCG has an in-house analytical team tasked with ensuring new data flows not provided through the CSU are collected and included in the Integrated Quality and Performance Report which is delivered monthly to clinical and executive leads through the Quality, Performance and Assurance Sub- Committee and quarterly through the Governing Body. 10

11 Performance Summary Constitutional Standards This section provides a summary of our performance against the NHS Constitution Standards during , and provides a commentary against these. 11

12 12

13 Performance Analysis This section provides additional detail, including information about how performance is measured and a more detailed integrated performance analysis. Finance Based on the draft accounts, the CCG has performed as follows with regard to its statutory duties: Expenditure not to exceed income The CCG s total income comprises the revenue allocations that it receives from NHS England together with any operating revenue that it generates. Allocations were received in the sum of m. During the course of the year, the CCG incurred operating expenditure of m leading to a deficit (spend exceeding income) of 7.285m. Expenditure on administration costs (Running Costs) not to exceed the limit set by the Department of Health. The CCG was given a running cost ceiling of 4.403m and the actual expenditure amounted to 4.403m. Expenditure on capital items not to exceed the limit set by the Department of Health. The CCG received a capital allocation of 0.133m in and the actual expenditure amounted to 0.133m. Better Payment Practice Code The Better Payment Practice Code requires the CCG to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. At the end of the financial year, the cumulative percentage for non NHS invoices is 98.7% by number and 99.3% by value. The performance in relation to NHS invoices is 98.3% by number and 99.0% by value. Both performance measures are above the 95% target. Sustainable Development We appreciate that the most successful organisations are those that can implement and sustain effective improvement initiatives leading to increased quality and patient experience at lower cost. Using the NHS Standard Contract, we require our providers to state how they are supporting sustainable development. The CCG is engaged, through the Health and Wellbeing Board and other local agencies, with resilience planning and creating a secure infrastructure that will help the local community remain sustainable when faced with sudden or disruptive events. 13

14 Internally, within the CCG, we have reduced our reliance on printed meeting papers; all of our committee and governing body papers are now published via secure electronic system meaning they no-longer need to be printed. We are also using electronic and social media to raise awareness; we have worked with other east Kent CCGs to develop the Health Help Now, the mobile optimised website and app for Kent and Medway, which help people find the right treatment for their symptom and avoid A&E. As of 26 April 2018, the website had been used over 343,000 times, and the associated downloadable app (available on Google Play and the App Store) had been used over 73,000 times. The CCG remains committed to minimising waste. This commitment includes an ongoing public communications campaign aimed at reducing medicines waste, which is a significant cost pressure on the CCG. We also encourage a paperless office and other waste reduction and recycling initiatives such as food waste bins in offices. We will continue to develop plans to assess risks, enhance our performance and reduce our impact. We will ensure the CCG complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act We will focus on how we can encourage our staff to adopt sustainable habits personally; and we will review how, as an organisation, the CCG can adopt sustainable approaches to its business. We are also setting out our commitments as a socially responsible employer. Improve Quality The CCG has a statutory duty to improve the quality of the services it commissions, and continues to place quality at the centre of discussions with providers. We make our expectations clear to our providers and closely monitor their performance against key quality standards. Provider organisations from which we commission care including acute, community, mental health and general practice - are required to meet essential standards of quality and safety, as defined within the Care Quality Commission (CQC) standards, and as commissioners we set quality requirements in addition to these. We work closely with these organisations, monitoring compliance with standards throughout the year and providing challenge and proactive support where standards are not as expected or required and support them in driving their standards to the highest possible level. The Governing Body, the Quality Performance and Assurance Committee and the Head of Nursing, Quality and Safeguarding work to ensure that the services the CCG commissions are safe, clinically effective and provide an excellent experience for our patients. 14

15 We have detailed contracts with the providers from whom we commission care. We carefully monitor their performance against a range of measures which include patient experience, patient safety and clinical effectiveness. The Commissioning for Quality and Innovation (CQUIN) payment framework ties part of a provider s income to quality and innovation requirements. These requirements - known as CQUINs - cover a whole range of areas, including training to ensure that staff receive the updates they need, and Friends and Family test results that look at patient experience and satisfaction. The CCG plays an active role in the Kent and Medway Quality Surveillance Group. This group brings together the different parts of the health system to share information. It is a proactive forum for collaboration, providing the health economy with: A shared view of risks to quality through sharing intelligence An early warning mechanism of risk about poor quality Opportunities to coordinate actions to drive improvement, respecting statutory responsibilities of, and on-going operational liaison between, organisations. As a commissioning organisation the CCG plays an active role in these groups to ensure good practice is spread, lessons are learnt, poor practice is challenged and recovery plans are monitored. In order to inform the Quality Surveillance Group and assure our governing bodies on the quality of care commissioned we have continued a schedule of quality visits to our main providers of healthcare. These visits have provided valuable opportunities to see services operating in real time from both a patient and provider perspective. The information gained from these visits has been shared with providers as well as being fed into the CCG s planning team so that we can enhance commissioned services and pathways to ultimately improve a patient s experience and quality of service received, while working collaboratively with providers to ensure changes are sustainable. We take a vigilant, zero-tolerance approach to breaches of the quality and safety of all our commissioned services and, led by our lay and independent members, have continued to adhere to a whistleblowing policy and procedure that sits outside of the management structures and provides independent overview and scrutiny while still affording individuals with the appropriate measures to ensure they feel able to raise issues without fear of reprisal in any form. 15

16 It is a priority for the CCG to work with the local health and social care economy across Kent and Medway and wider to address aspects of patient safety and ensure that lessons learnt are embedded in order to prevent harm as well as being shared across the system. We also have encouraged learning from where things have gone well. It is recognised that there are risks on individual risk registers that are system wide risks and require a system approach. The local health and care economy recognises the need to implement an approach to jointly manage risks with all relevant internal and external stakeholders, and to be clear about our respective risk appetite for new and innovative approaches to delivery in the context of financial and other constraints. During the coming year, the four East Kent CCG s will be working more collaboratively with each other and the providers they commission to gain assurance and drive improvements in quality, outcomes and experience for our patients. Whilst we recognise some of this will need to be delivered on a large footprint we also recognise that the approach will need to be tailored in each of the four CCG s in order for it to meet the local care needs. We are committed to sharing our resources, being open and transparent in our approaches but focused on achieving safe and effective care for our population. Primary Care Commissioning The CCG, through delegation from NHS England, became responsible for the commissioning of primary medical (GP) services from 1 April To exercise this responsibility, the CCG established a Primary Care Commissioning Committee and a Primary Care Operational Group. The CCG continues to work hard to maintain the confidence of our GP Practices to undertake this role whilst growing our knowledge and skills of delegated commissioning. Every GP practice of the CCG has been inspected by the Care Quality Commission (CQC). The majority of our practices (83%) have received at least a Good rating. The CCG Nursing and Quality Team work closely with practices that have areas that require improvement, with support focused on practices to strengthen areas such as safeguarding, infection control, incident reporting, workforce development and patient engagement. The CCG continues to develop our GP premises knowledge and over the last year we have reviewed all premises to ensure they comply with minimum standards listed in the National Premises Costs Directions 2013, meet requirements for infection prevention control and a number of practice rent reviews have been progressed. The CCG has also worked closely with both Dover District Council and Folkestone and Hythe District Council (formerly Shepway District Council) to secure health contributions from all proposed housing developments and have produced an estates strategy which sets out how health investments will be utilised. 16

17 In the last year the CCG has been delegated additional commissioning responsibilities from NHS England including the Violent Patient Scheme, Translation Services, Clinical Waste as well as the In and Out of Season Management of Flu and schemes for patients who are registered in places other than where they live. The NHS landscape continues to evolve with the Kent and Medway Sustainability Transformation Plan (STP) continuing to drive forward a system wide approach to developing local care models across Kent and Medway. This is at a time when primary care is trying to respond to and implement new initiatives and ways of working set out in the GP Forward View including improving access to GP Services. During the last year the CCG has seen the number of practices reduce from 30 to 29 due to one practice closure. The CCG is also exploring opportunities for further collaborative working across east Kent. Engaging people and communities NHS South Kent Coast Clinical Commissioning Group (CCG) aims to ensure the patient and community voice is embedded into its commissioning cycle so that it can become a valuable, high-performing and successful local NHS organisation. Our approach to communication and engagement is influenced by three main objectives: Listening to, and acting on, the views of our community by involving and engaging with as wide a range of the public as possible. Targeting services effectively to areas of particular need by using information and research about different communities needs. Increasing our reach into communities where evidence shows further engagement is needed. We would like to thank the lay member Clive Davison, Patient and Public Engagement (PPE), who as a member of the Governing Body (retired in February 2018) has championed the involvement of local people. He has spent time working with the three chairs of locality groups of the Patient Participation Groups from Deal, Dover and Shepway. He has involved them in the work to develop integrated accountable care and he has also continued to meet patients and representatives from local voluntary and community groups through the South Kent Coast area Health Reference Group, and with individual patients and carers who attend the wider public discussions on commissioning plans. The lay member for PPE is part of several strategic committees and planning groups, such as the Kent and Medway Patient and Public Advisory Group (PPAG), to advise and inform the engagement and communication needed so that local people can be actively involved in the 17

18 planning, development and delivery of the wider Kent and Medway Sustainability and Transformation plan (STP) to deliver the five year forward view set out by NHS England. This also ensures a join up between the grass roots discussions at a local level and makes sure the work feeds into the more strategic plans. Each member of the PPAG has joined one of the main workstreams and Clive Davison was on the productivity workstream. Patient Participation Groups Every GP practice has a Patient Participation Group (PPG) who can support their practice in a number of ways so it can: Be responsive to patients experience to improve quality of care Plan for service delivery Support local patients to maintain their health and wellbeing. This year we have worked closely with PPGs and those patients where the GP practices were closing or merging. Practices all over the country are facing the same difficulties fewer doctors and increasing demand for services. In Folkestone, we also had a particular challenge following the decision of the partners to close Folkestone East Family Practice from 31 October Everyone has a legal right to be registered with a GP practice and the CCG has a legal responsibility to ensure this. We have done our utmost to work with the practices and the patients to make sure everyone knew what was happening and had support and information to sign up with an alternative practice. We know it is very difficult for everyone involved when this happens and would like to thank patients for their understanding in these difficult circumstances. South Kent Coast Health Reference Group The CCG regularly meets (every two months) with the representatives from the GP practices PPGs to discuss the broader issues involved in planning, designing and paying for health services to discuss individual commissioning priorities, review engagement plans and contribute to the consideration of services by the CCG. This year the health reference group have looked at: Mental health Integrated local care 18

19 Planned care provision in French hospitals Porchlight and their work in GP practices East Kent childrens commissioning team and their plans South East Coast Ambulance Service NHS 111 and the out of hours service Sustainability and Transformation Plan (STP) and the work of the Patient and Public Advisory Group (PPAG) Kent and Medway Stroke Consultation The Health Network South Kent Coast Health Network is a virtual group of 349 patients, carers and members of the public recruited through a recruitment drive on the streets, at markets and school fairs. Three hundred and fifty organisations, mainly community and voluntary groups, are also part of the network. We share opportunities for them to be involved throughout the year with surveys, attending discussions, sharing their experiences of different services or commenting on plans and proposals. In this way feedback from the network helps the CCG decide how local health services are planned and designed. Anyone who becomes a member is given the opportunity to participate as often or as little as they like. This year views have been sought on: the Kent and Medway STP, local care, on suggested changes to prescribing in primary care, and the consultation on stroke services as well as diabetes. They receive a regularly monthly bulletin updating them on the actions taken by the CCG in light of their input and other commissioning plans and activities; and also the quarterly patient newsletter. Engagement activities which support the commissioning cycle Six "Listening Events" were held in East Kent locations during June and July 2017 to help further develop plans to improve health and care in the area. The events focused on the work being developed to improve the range and quality of NHS services available in local communities and 19

20 GP practices, and how the hospital services will be organising to make the most of their skilled teams. There were two events, in Deal and New Romney, which provided an opportunity for people to find out more. Sixty eight people came and provided their feedback and views, as well as ask questions about these developments, including the hospital care workstream of the Kent and Medway STP, which in east Kent is focusing on urgent and emergency, acute medical and elective orthopedic services; and stroke and vascular services across the whole of Kent and Medway. These services have been assessed as most in need of change to make sure they consistently meet national quality standards. Themes we have heard and acted upon: In principle the ideas are good, but we have a few concerns about the capacity to deliver in terms of workforce and cost. Move faster; 2019 is too long. The stroke review is taking too long to act. Integration is welcomed, we like seeing the partnership working, and we want the Voluntary and Community Sector to be part of the plan. It is important to retain personalised care. Everything was written up and sent to independent analysts who reported on their findings. This is being used to shape the plans of the progamme board and the work streams as they develop more detailed plans. Engagement staff and volunteers have also been attending local community events, late night shopping, farmers markets and country fairs to share the developments with a wider audience sharing copies of the STP newspaper and case for change. The full report is on the both the CCG website and the STP website: East Kent engagement contributes to two national consultations on changes to prescribing guidance for primary care. A brief engagement exercise was undertaken across east Kent from August to October to publicise the national prescribing guidance consultation, and collect the views of local people in east Kent. A document was produced in plain English to explain the proposals and give 20

21 people sufficient information to respond. The document also promoted the national consultation and gave links to it for those who wished to understand the detailed proposals. Five thousand copies were distributed in GP practices and pharmacies across east Kent, together with hard copies of the survey. The survey was also available online on the CCG website, and was promoted through banners on the home page, a news item and press release. The consultation and survey were promoted, and demonstrated at local patient reference groups including PPG chairs. Participants were asked to cascade the link to their social and professional networks. s with the information documents and links to the survey were sent to the health network, regular patient groups and community networks. Partner organisations within those networks, such as Healthwatch Kent and Red Zebra, were asked to promote and cascade the information through their volunteers and networks. The survey ran between 11 September and 2 October In total 378 survey responses were received, 288 via the online survey and 90 as paper-based responses posted to the Freepost address, postmarked within the deadline. Seventy-nine per cent of survey respondents (299 out of 378 people) gave information on where in east Kent they came from. There was strong support for the proposal to restrict prescription of medicines for minor ailments or illnesses which are widely available over the counter in shops and pharmacies: 86 per cent of the 361 people who gave their opinion strongly agreed or agreed with the proposal and only four per cent strongly disagreed. More than 80 per cent of respondents (300 people) supported NHS England s suggestion to change prescribing guidance for medicines that can be dangerous or are ineffective. When considering the impact such a change might have, 90 per cent of respondents agreed they would find it very easy or fairly easy to find over the counter medicines, and 89 per cent would find buying these easily or fairly affordable. Our medicines management team drew on the full report of the engagement, with analysis of feedback, to inform their formal submission to the two national consultations. Kent and Medway Children s Summit As part of the STP, a Kent and Medway Children s Summit, involving all the local heath and care leadership, was held at the end of September Three short films were shown to involve and evidence the real experiences of children services. These films were of parents sharing their positive and less positive experiences, to help attendees understand what it s like to be in a system. As a result of this the leaders attending the summit agreed that a year of action the year of the child (April 2018 March 2019) was needed in Kent to improve the support offered to 21

22 children and their families and address the findings from the Royal College of Paediatrics. The Royal College has published a report which said that services were fragmented and too disparate without integrated pathways of care. To start this, the Royal College is facilitating a collective process where all providers work together to improve the connectivity across services for children and their families, and increase the understanding and integrated working across services. This work began with integrated workshops in January System Transformation In east Kent, we are looking at how local health and care services can be delivered in a more joined-up way. These will help people get care that looks after them as a whole person, rather than treating their different conditions separately. It will also mean people can get more care and support in their local community, with more services provided at GP surgeries, community hospitals or other bases. A Design by Dialogue event was held on Thursday 22 March at Canterbury Cricket ground. Over 80 people joined NHS leaders and their partners in social care to discuss the healthcare questions and issues which they feel need improving. The event was led by Caroline Selkirk, the new Managing Director for East Kent. The aim was to start a dialogue and generate a shared understanding of the challenges and opportunities we all face around health and care, and to start a way of working that ensures collective action can make a positive difference to the health and care of people across east Kent. All the views, questions and comments are currently being typed up and a short feedback bulletin/newspaper will be produced by the facilitating group: Public Engagement Agency. This will be followed up by seven locality events as part of the wider engagement towards developing proposals for changes across the health and care system. Stroke consultation Ten clinical commissioning groups in Kent and Medway, parts of south London and East Sussex are leading a consultation on improving urgent stroke services. Currently there are no hyper acute stroke units in Kent and Medway. The proposed new units would be staffed by specialist teams made up of consultants, therapists and nurses, offering specialist care 24 hours a day, seven days a week with access to brain scanning equipment and clot-busting drugs (thrombolysis). The units would have enough staff to review scans and provide thrombolysis swiftly, with consultant ward rounds at least once a day, seven days a week. People would be admitted directly to the unit avoiding waits in A&E, meaning patients and carers get fast, high-quality care and the information and support they need. 22

23 There were many ways in which people could be involved: by attending one of 28 public events, completing an online survey, sending in their views by or letter. There was a huge amount of information available via the STP and CCG websites: 98,222 leaflets have been distributed door to door and there were specific processes to ensure a representative sample of the public takes part in a telephone survey, outreach work through Healthwatch and the CCG engagement team attended community meetings and events to capture views from as broad a range of the population as possible, and some specific work with groups who are known to be hard to reach or are most likely to be affected by proposals. Hard copies of the consultation document, and summary were distributed through GP practices, hospitals, libraries and community venues. More than 1,500 people have responded by the beginning of April and extra public meetings, and an extra week, was added to make the process as inclusive as possible. All the feedback received will be typed up and shared with independent analysts who will collate and analyse the responses and this information will together with the clinical information and data be considered by the joint consultative committee before a decision will be reached. Monitoring and Evaluation Patient Transport Service G4S took over the contract for delivering non-emergency patient transport on 1 July 2016, against a new service specification which was informed by patient and public views and contains the Kent Patients Charter for Patient Transport. We thought it prudent to check with patients using the service to gauge their experience. Therefore, we ran a survey across Kent and Medway involving the health network, our partners in the voluntary sector and hospital staff who book the service for patients, to encourage people to tell us about their experience. People who responded to the survey were generally positive about the staff providing the patient transport service, and most people had a satisfactory experience of their journey. However, their answers flag up concerns about: Transport arriving on time and getting them to and from appointments on time The appointment booking system Whether eligibility criteria are being explained simply enough Arrangements for people who have very short appointments (and who may experience long waits which could be avoided if ambulances waited for them) Arrangements for carers and consistent application of the policy on carer travel 23

24 Overly long journeys Knowing how to complain Communication by the PTS team. The actions taken as a result are: to improve the ways hospital staff have of alerting G4S to problems with the service on behalf of their patients, and the detailed way in which complaints and issues highlighted by patients and carers are reported to commissioners. G4S is also putting in place an action plan to address the serious issue of time keeping highlighted by patients: this will be monitored by commissioners in performance meetings Tiers of care survey The east Kent CCGs strategic vision for the prevention and management of long-term health conditions is to have integrated Tiers of Care pathways across the area. This is to ensure that patients have continued access to combined services, including prevention for those at risk, diagnosis, management of complications, inpatient care and end-of-life care; with an aim of reducing both the current increasing prevalence of long-term conditions and the negative effects of these conditions on the lives of patients. The intention is to shift the balance of how some of these services are delivered, so there is a more effective use of the expert staff in all of the tiers of care (set out below). This would mean that overall the NHS provides a more joined-up service closer to home for patients and their families. Tier one primary care Tier two community services/secondary care/gps with a special interest Tier three acute services The first services to be piloted are rheumatology, respiratory and cardiology. The Care Closer to Home survey was developed with commissioners to evaluate service change. The first round of data collection will establish a baseline of patient experience of existing services, before any changes are implemented. A second survey will be run in six months time, once changes are made and new services are in place, to evaluate the impact in terms of patient experience of care delivered differently. The survey was completed by patients while attending a variety of outpatient and follow up appointments from late October to December The survey was also available via an online questionnaire and a freepost address provided should patients prefer to complete it at home. The survey consists of 17 questions focusing on the quality of service delivered, important aspects of their care and what (if any) improvements patients would like to see. In total, there were 210 responses from patients across all three services in east Kent. In the main, patients are very happy with the current level of service provision and praised the 24

25 professionalism and friendly attitude of staff. They also commended the information given and the time staff gave them to discuss issues such as medication. When asked about improvements to the service, in cardiology the start time of the clinics were questioned. In rheumatology, 53 responses were received. The majority of comments mentioned the punctuality of staff, and the waiting time in clinics. Another common theme was the amount the healthcare professional knew about their specific history, with some comments mentioning new or temporary staff knowing little about their state of health. Thirty two people commented upon respiratory services. The most common theme was the waiting times for outpatient clinics and the length of time from referral to appointment bookings. Also notable was the dissatisfaction among respondents about how long they waited for test results. Procurements Children and Young people s mental health services In 2017 we concluded a yearlong piece of work with patients about mental health services for children and young people. More than 100 children and young people were involved by helping to define the standards they want from a new service. A small group of six took part in the formal procurement process. Then more than 30 worked on creating an animated film ( and interactive survey to promote and assist in evaluating the newly procured children and young people s mental health service which went live in September Reducing health inequality CCGs play a key role in addressing equality and health inequalities; as commissioners, as employers and as local system leaders, in creating high quality care for all. The World Health Organisation (WHO) defines health inequalities as differences in health status or in the distribution of health determinants between different population groups". There is clear evidence that reducing health inequalities improves life expectancy and reduces disability across the social gradient. Tackling health inequalities is therefore core to improving access to services, health outcomes, improving the quality of services and the experiences of people. It is also core to the NHS Constitution and the values and purpose of the NHS. Avoidable health inequalities are by definition - unfair and socially unjust. A person s chance of enjoying good health and a longer life is determined by the social and economic conditions in which they are born, grow, work, live and age. These conditions also affect the way in which people look after their own health and use services throughout their life. Addressing 25

26 such avoidable inequalities and moving towards a fairer distribution of good health requires a life course approach and action to be taken across the whole of society. The CCG has a statutory responsibility to reduce health inequalities, working with our Health and Wellbeing Board to do so. Our programme management approach to commissioning for value ensures that the impact on addressing inequality is assessed when planning and commissioning local healthcare. All business cases for a new service require an equality impact assessment to be completed prior to approval. We ensure that all of our staff receive Equality and Diversity training, and have designed this to ensure that it not only promotes equality and diversity within the workplace, but also raises awareness of equality within the local community enabling all staff to gain a thorough understanding of the importance of considering equality during service design and commissioning. Health and wellbeing strategy Established and hosted by local authorities, health and wellbeing boards bring together the NHS, public health, adult social care, district councils and children's services, including elected representatives and Local Healthwatch, to plan how best to meet the health needs of their local population and tackle inequalities in health. We are active members of the Kent Health and Wellbeing Board; the Board is required to publish a strategy that sets out how commissioners will be supported to plan and commission integrated services for their whole local community, and in particular for the most vulnerable individuals and the groups with the worst health outcomes. The Board published the Kent Joint Health and Wellbeing Strategy and reviews our operational plans on an annual basis to ensure that they are broadly aligned to the strategy, and will assist with achieving its aims. The Board has established a schedule of reviewing reports on specific outcomes from the strategy and considering them in detail, to provide assurance that the plans are delivering as intended. During 2016/17, the planning guidance published by NHS England changed; a two-year planning cycle has been introduced plans now need to be aligned to the Sustainability and Transformation Plan plans for the coming year now need to be published by the end of December rather than the end of March 26